These guidelines for management of alopecia areata have been prepared for dermatologists on behalf of the British Association of Dermatologists. They present evidence-based guidance for treatment, with identification of the strength of evidence available at the time of preparation of the guidelines, and a brief overview of epidemiological aspects, diagnosis and investigation.These guidelines were commissioned by the British Association of Dermatologists Therapy Guidelines and Audit subcommittee. Members of the committee are N.H.Cox (Chairman), A.

No abstract

In our study normally painful electrical stimuli elicited itch in a patient suffering from HES-induced pruritus. This reaction was most pronounced in those skin areas in which spontaneous itch was perceived. As the tested skin sites did not show the expected spreading erythema during neurogenic inflammation induced by depolarization of sensory nerve fibres, there is no evidence for a peripheral sensitization process. In addition, peripheral sensitization would be expected to enhance pain sensitivity and therefore pain ratings would increase, sensations that were clearly not enhanced in our patient. Thus, we conclude that the most probable explanation for the electrically and mechanically induced itch is sensitization of the spinal processing of itch. Ongoing activity of peripheral 'itch-neuron' itch receptors has been proposed to induce and maintain the state of hypersensitivity to pruritic stimuli in the spinal cord. 8 Our results cannot explain the mechanism by which the peripheral itch receptors are activated in the HES-treated patient. However, the identification of central sensitization as a component of this clinical itch condition might have therapeutic implications; in neuropathic pain conditions central sensitization has been successfully treated by gabapentin. 9 It will be of major interest to explore further the therapeutic implications of central sensitization for the treatment of pruritus induced by HES.